Longitudinal patterns of Medicare use by cause of death.

To study the use of health services before death for different causes, a 6-year file of Medicare use and cost data was linked to a file of death certificate information for persons dying at ages 65 years or over in 1979. Patterns of medical care use during the last years of life varied substantially by cause of death, reflecting the degree of chronicity of the disease that resulted in death and the nature of treatment. Persons dying of nephritis, chronic obstructive pulmonary disease, and diabetes mellitus incurred consistently high expenses for 6 years before death. Costs for cancer decedents were also high, especially in the last 2 years of life. Persons in their last 2 years of life have a considerable impact on Medicare expenses. An estimated 13 percent of annual Medicare expenses were attributable to persons who were within 2 years of death from heart disease and 10.7 percent to persons who were within 2 years of death from cancer.